Questions to Ask Explant Surgeons

Questions to Ask Explant Surgeons

The following is a comprehensive list of questions to ask explant surgeons during your consultations. Asking these questions will help you find a surgeon dedicated to proper explant which is an En Bloc / Total Capsulectomy explant. There are also important questions to ask about pathology, recovery, after care and about having your implants returned to you. 

  1. Are you a board certified Plastic Surgeon? Do you have hospital privileges? Do you have medical malpractice insurance? If a surgeon has their own surgical suite but does not have hospital privileges, find out why.  Having hospital privileges is key to ask as it means they are trained and certified in plastic surgery and in good standing with the medical community. Also hospital privileges are important if you were to  have a serious complication during surgery that would require entry to a hospital to save your life and a surgeon without hospital privileges cannot help you in those circumstances. Surgeons lose their hospital privileges for significant reasons and you should be aware of those reasons but may not have access to the information unless you ask.   Surgeons lose their malpractice insurance too for serious reasons such as multiple malpractice suits and you may not have access to that information unless you ask.  Is the surgical facility accredited? Learn more about surgical facility accreditation here: http://www.americanboardcosmeticsurgery.org/patient-resources/facility-accreditation/
  2. Ideally breast implants should be removed En Bloc Capsulectomy if possible and always with a Total Capsulectomy which means remove all capsule tissue including capsule tissue attached to the chest wall.  En Bloc is important for ruptured,  leaking, bleeding silicone and textured implants to minimize silicone contamination to you.  Total Capsulectomy may suffice for smooth saline implants if you are not symptomatic but if you are symptomatic you may want En Bloc Capsulectomy for smooth saline too.  For all explants of breast implants all capsule tissue should be removed from your chest  for your highest and best recovery from breast implant illness symptoms because capsules are full of silicone gel, particulate and biofilms of infectious organism.  Do you have En Bloc Capsulectomy explant skills and experience?  How long have you been explanting and how many En Bloc explants have you done?  Do you have Total Capsulectomy skills and how many Total Capsulectomies have you done? They should have at least 50 or more under their belt. Can you provide photos of previous En Bloc / Total Capsulectomy explants?  Will you provide photos of my En Bloc / Total Capsulectomy explanted capsules and implants evidencing entire removal of capsule tissue?  Photos are the only way they can prove they removed your implants En Bloc / Total Capsulectomy. Are you committed to removing all capsule tissue from my chest including capsule tissue on the chest wall and will the surgery contract state Total Capsulectomy to ensure this commitment? Choose a surgeon that is committed to removing all capsule tissue from your chest as we know that removing capsules correlates with our healing from breast implant illness.  How long will the surgery take? Thorough En Bloc / Total Capsulectomy explants usually require a general anesthetic and take approximately two hours or longer of surgery time.
  3.  Do you do muscle repairs and or inframammary fold reconstruction if necessary?  Here is a good video explaining why muscle repairs may be necessary.  Inframammary fold or crease reconstruction is ensuring the anatomical breast crease lands in the same area it should after larger implants are removed. 
  4.  In regard to BIA-ALCL, if you have swelling, seroma, breast mass or capsular contracture and textured implants, please push for BIA-ALCL testing upon removal of your implants. If a seroma is discovered during explant will you aspirate and send the fluid and capsules for CD30 Immunohistochemistry to rule out BIA~ALCL? Please do not assume that surgeons automatically know to do this, many do not know and discard the fluid. We have to educate explanting surgeons to do the CD30 test and to follow proper testing procedures for BIA-ALCL which is likely more widespread than the medical community acknowledges.
  5. Can I see an advance copy of all presurgery paperwork that must be signed. Do I have to sign a confidentiality agreement or a non-disclosure agreement with this surgeon? This is a relatively new angle that surgeons have come up with after the consult and deposit are paid and right before the surgery they attempted to force patients to sign a nondisclosure/confidentiality agreement so the patient cannot report their surgery experience online.  We suggest walking away from surgeons trying to force confidentiality agreements.
  6. What kind of anesthetic is used during surgery and what can I expect with it? Is anything else added to the anesthetic and if so how will it affect me? If I am MTHFR positive will my condition affect anesthesia procedures? MTHFR people are recommended to avoid Nitrous Oxide as it greatly depletes B12 levels which exacerbates our symptoms.
  7. Will I receive antibiotics during the surgery, what kind will be used and how will they affect me? Will I receive any other medication such as an anti-nausea medication? Some surgeons use steroids during surgery. Lyme ladies should be cautious about steroids as they can worsen Lyme.
  8. Will you use cautery during surgery which reduces bleeding? How will you control bleeding or blood clotting if necessary to do so? Will the stitches be dissolvable or do they have to be removed? Will any foreign materials be used such as staples, permanent stitches, mesh etc? We highly suggest against all foreign materials because these cause symptoms too.  Some lift procedures use mesh and we highly advise against mesh or other similar products as it causes problems too.
  9. What kind of pain medication will be prescribed and how will it affect me?
  10. Are pieces of capsule tissue sent to pathology to check for bacterial and fungal infections and also the rest of the capsule to check for silicone, various immune reactivity cells, cancer or BIA-ALCL if applicable. Do you send the implants to pathology to document their state and if they are leaking or ruptured. Will you test saline fluid for colonization by microorganisms such as mold if applicable by sending to labs that test for fungus such as Mycometrics or Real-Time Lab? How much will any of this testing cost?
  11. What do you do to clean out the chest pocket if it is contaminated with silicone and or microorganisms?
  12. If you are dealing with a grossly ruptured silicone implant where silicone travelled to the lymph nodes, does he check lymph nodes for silicone through ultrasound and localization techniques and remove lymph nodes that cannot be saved?
  13. Do you take pictures or video of the explant procedure? We recommend getting the following video or pictures signed off by him; one of you with your implants still in before surgery, one of you after explant without your implants while on the surgery table, picture of the implants with capsule tissue still on to prove En Bloc removal and pictures of the implants and capsule tissue separately to document capsulectomy. 
  14. Can I have a copy of my complete file including operative reports, pictures and tests at our first follow up meeting?
  15. Will you pack up and return my uncleaned implants and capsule tissue to me if I request? Or send them elsewhere if you request? If you are interested in legal, check with your attorney about how your implants should be handled to preserve your case. 
  16. Will I have drains and what should I expect with drains and how will I care for drains while I have them? Who will remove the drains?
  17. What are the signs of an infection after explant? What are the signs of a seroma or hematoma after explant? What are the procedures if symptoms of these occur?
  18. If you are explanting due to rupture, capsular contracture, pain or infection and your insurance covers you for explant will the surgeon work through your insurance or provide you the letters required for you to apply to insurance for a reimbursement yourself?
  19. Is there a deposit required and what happens with the deposit if I have to cancel or postpone at anytime?
  20. What are pre-surgery directions for avoiding supplements and medications and what are after surgery directions for compression, wound care, sleeping, massage and who will I call if have problems or questions after surgery?
  21. Will he prescribe antibiotics for bacterial infections in the chest or antifungals if the implants are colonized with fungus or if you experience an overgrowth of fungus in the gut and body due to antibiotics from surgery.
  22. How long will it take for my breasts to heal and feel normal? When will the follow up appointments be and how many? What can I expect in terms of size of explant incision scars.

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